NEW ORLEANS — Women and their doctors are concerned they could lose access to the latest types of reconstruction after breast cancer.
That's because there's a proposed federal change in medical insurance billing codes, which could mean insurance companies will only reimburse for the older, less-advanced surgery, making co-payments out of reach.
In 2012, women celebrated outside of The Center for Restorative Breast Surgery. They celebrated mandates that insurance companies pay for breast reconstruction after cancer, and surgery on the opposite breast for symmetry.
This helped breast cancer survivor Joanna Ford, 62. Many years ago, back home in Panama City, Fla., she had reconstruction after cancer using implants.
“It was really not attractive. Every time I took a shower, it's like there it is, and it was just a reminder that I had cancer, and wow, that can kill you,” Ford said.
Afterward, her breasts did not match. There was a difference of two cup sizes.
“So, for the past 12 years, 13 years, I've been stuffing a sock in my bra, then I gained weight. So, I ended up with, I tell my friends, a melon and a small orange,” she joked, explaining that she really used padding, rather than a sock.
So, Ford came to the world-renowned Breast Center in New Orleans to get a flap reconstruction from her own natural tissue. She no longer has implants. Fat from her abdomen was microsurgically transferred to the breast.
Ford said she is concerned that soon women won't have the same options. A federal agency is planning to combine all different types of flap breast reconstruction procedures together under one insurance cost code by the end of 2024.
Some surgeons have also been concerned. If the insurance codes change, they won't be able to bill insurance for the more advanced type of reconstructive surgery, because it won't even cover their costs.
So, that means women would have less access to getting the latest surgery, and if they do get it, there may be a much longer wait.
After waiting 13 years for the advanced flap surgery, Ford feels like her natural self, with her own tissue that can grow or get smaller.
“Genius. Genius. This is such a genius type of surgery. Ever since I had this done, and I'm like I told my friends too, I don't even think about it, and so it's really more about being whole,” Ford said.
The federal agency, Centers for Medicare & Medicaid Services (CMS), that oversees coding, is planning a hearing Thursday, to reconsider that change.
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